Let’s talk about head and neck cancers

When we look for signs and symptoms of cancer, head and neck cancers or ENT (ear nose, throat and throat) cancers may not be on our minds. Sometimes, the symptoms and signs of certain cancers are not obvious at all. This can delay their diagnosis.

It is important to be aware of the symptoms and signs that these cancers can present so you can detect it and get treatment started as soon as possible.

Continue reading to find out about common ENT cancers like nasopharyngeal, throat, and voice box cancer, as well as their warning signs, and the treatment options.

Nasopharyngeal Cancer

The top 10 most common types of cancer for men between the ages of 30 and 59 in Singapore is nasopharyngeal cancer. It is when cells just above the mouth and throat become cancerous.

*National Registry of Diseases Office: Incidence of Cancer in Men Between 2015 and 2019

The appearance of nasopharyngeal carcinoma can mimic other conditions and often goes untreated until it is too late.

Here are some symptoms and signs to watch out for:

• When cancer cells have spread to lymph nodes, there will be lumps on the neck.
• Tinnitus, hearing loss, or blocked ear can cause ringing in the ears.
• The throat and nose are soiled with bloody phlegm.

Nosebleeds that recur

Blot nose, particularly on one side and sudden

Risk Factors

There are certain risk factors that increase the likelihood of developing nasopharyngeal carcinoma.

Family history

Ethnicity (higher rates of Chinese being ethnic)

A diet that is high in salt-preserved fish and low in fresh fruits and vegetables.

Past Epstein-Barr virus* (EBV) infection

*EBV infection, a common viral infection, usually causes mild symptoms such as fever and soreness and has been linked with the development of nasopharyngeal carcinoma. EBV by itself does not cause nasopharyngeal carcinoma. EBV alone is not a factor that can lead to nasopharyngeal carcinoma. However, EBV in combination with other factors like genetic susceptibility and/or environmental risk factors may result in nasopharyngeal tumor development.

Diagnosis

Your doctor will perform a complete examination to determine the cause. To determine if the cancer is present, diagnostic tests may be necessary. These tests are examples of diagnostic ones:

Nasendoscopy: A long, narrow, flexible tube with a camera at one end that is inserted into your nose to check for any abnormalities.

Biopsy – A small amount of suspicious tissue is removed and examined under the microscope to determine if there are any cancer cells.

Blood test – Due to the association between EBV & Nasopharyngeal Cancer, blood tests can detect antibodies to EBV or EBV DNA, which can help early detection and screening for Nasopharyngeal Cancer.

Your doctor will perform further tests to confirm the diagnosis of cancer. These include MRI (Magnetic Resonance Imaging), CT (Computed Tomography) scan and PET (Positron Emission Tomography). This is done to determine the stage of cancer so that the appropriate treatment can be provided.

Treatment

Radiation therapy is used to treat early stage nasopharyngeal carcinoma. Advanced stages will require chemotherapy and a combination of radiation treatment. For residual disease (when some cancer remains) or recurrence (when the cancer returns to the original treatment), surgery is not recommended.

Cancers of the Throat and Voice Box (Pharyngeal Cancer).

These are tumours that develop in the throat, around the voice box or inside the voicebox. The area below the vocal chords (supraglottis), above the vocal chords (glottis), and under the vocal chords (subglottis).

The voice box allows us swallow and talk, and symptoms could affect these functions.

These are signs and symptoms you should be looking out for:

• Voice changes, such as hoarseness lasting more than a few months, can occur.
• Consistent sore throat
• Lump(s), in the neck
• Toughness or pain when swallowing
• Difficulty in breathing
• Earache
• Risk Factors

There are several factors that increase the risk of developing cancer.

Smoking

• Alcoholism is a problem.
• An infection of human papillomavirus, or HPV (human papillomavirus)

Diagnosis

The first step in diagnosing you is to discuss your medical history and any symptoms that you have experienced. A physical exam will follow to determine if there are any sores or lumps around the mouth or swelling of the lymph nodes.

Additional checks may also be performed:

Nasopharyngolaryngoscopy – an endoscope is inserted into the nose, throat or voice box to examine it for signs of cancer. If lumps or tumours are found, a biopsy will be done to confirm the diagnosis.

Laryngoscopy: An endoscope is inserted into your throat and larynx in order to determine the extent of any tumours. The procedure is performed under general anesthesia. A biopsy is usually done to confirm the diagnosis.

Panendoscopy is an examination of the larynx and oesophagus using an endoscope. It can be done under general anaesthesia in just one session. As necessary, biopsies may be performed to rule out other cancers at similar risk areas.

Your doctor will perform further tests to determine the stage of throat cancer and voice box cancer.

Treatment

The location of the cancer, the size and stage of the tumors, as well as your overall health, will all influence the treatment that is recommended. Radiation therapy or surgical removal may be required for early stage cancers. Advanced stage cancer requires surgical removal of the tumor and then chemotherapy. Surgery may be required to remove any remaining or recurrent cancer cells.

Thyroid Cancer

Thyroid cancer is the 8th-most common cancer in Singapore among women. Thyroid cancer affects the thyroid gland. It is located just below the Adam’s apple at the base. The hormones produced by the thyroid regulate heart rate, blood pressure and cholesterol levels as well as body temperature, weight, and body temperature.

Thyroid cancer is when the cells of the thyroid gland become mutated and grow into tumours. Thyroid cancers can be treated, particularly in younger patients. There are excellent long-term cure rates.

Signs

Thyroid cancer can present few symptoms in its early stages. As the cancer progresses, patients may begin to notice a lump or mass around the neck. Although most thyroid lumps are benign and not cancerous, further investigation is necessary to distinguish between cancerous and non-cancerous. You should be aware of the following signs:

• Lump(s), at the front of your neck
• Voice hoarseness
• Difficulty swallowing
• Pain in the neck at the location the thyroid is located
• Swollen lymph nodes (lumps on the sides of the neck)

Risk Factors

The following factors can increase your risk of developing thyroid cancer:

Thyroid cancer in the family.

High radiation levels, particularly in the neck and head area.

Diagnosis

The first step in diagnosing thyroid problems is to discuss your symptoms and family history. To check for thyroid abnormalities such as a lump or thyroid nodule, your doctor might perform a physical exam of your neck. Your doctor may also request one or more of these tests:

To test your thyroid hormone levels and determine if your thyroid functions properly, you can do a blood test.

Ultrasound Imaging – High-frequency sound waves can be used to create an image of the thyroid and show any nodules. If suspicious lumps are found, a biopsy may be requested.

Fine-needle biopsy – Using ultrasound to locate the lump or nodule, a thin needle is inserted into the nodule to extract the cells. The nodule is then examined under a microscope for signs of cancer.

If the cancer has spread to the lymph nodes of the neck, additional imaging scans like MRI or CT scan may be required.

Treatment

The type and size of thyroid cancer and the extent of the disease will determine the treatment that is recommended. The following treatment options are available:

Surgery – This could involve the removal of half or all of the thyroid gland. Depending on the stage and extent of cancer, it may be necessary to remove lymph nodes from either the centre or sides of the neck.

Radioactive iodine therapy – This is sometimes required after surgery. The patient will consume a small amount of radioactive Iodine. This is to remove any thyroid tissue left after surgery, or any cancer cells that may have spread but remain undetected. This decreases the chance of cancer returning.

Hormone therapy – The body cannot produce the hormone thyroid after the whole gland has been removed. Therefore, medication must be used to replace it. To suppress thyroid stimulating hormone (TSH), a higher dose is often used. This would promote the growth of cancer cells and lower the chance of recurrence.

Radiation Therapy – Used when surgery is not possible to remove the entire tumour or to treat thyroid cancer that has spread from other locations like the bone.

Targeted therapy or chemotherapy – This is only necessary in advanced thyroid cancer, which has spread beyond the lymph nodes and if the thyroid cancer does not respond to radioactive Iodine treatment.